Introduction to National Service Frameworks - Assignment Example

?FOCUS: The National Service Framework for Older Adults – Stroke (Standard 5) The role of the nurse within the stroke pathway Introduction In this modern world medical science has made its transformation in a severe way. Still the world is not disease free. Various types of health hazards take place every minute around the globe. Among which stroke ranks third and considered as most life battling hazardous. (Cross, 2007, p.35) But stroke is preventable and treatable disease if proper care is taken. (Turner, 2008, p.32) This report is going to convey the role of a nurse within the stroke pathway. What measures can be taken to prevent this and in such cases how the patients should be treated. The goal of National Service Frameworks to deal with older adults in stroke pathway. The aim of this to report is to identify the health policy on care delivery from practical life. To ensure that the public and the professionals understand the cause of stroke, the symptoms of a stroke and what measures should be taken if someone gets an attack. The discussion of the report will follow the description on stroke and related issues, how efficiently NSF works towards its perspective to take care of the patient and their family. The main objective is to get the clear idea of the role of nurse, post stroke nursing care along with the inter-professional team. Apart from this other various health promotion to raise awareness also would be the part of the discussion. 2. Introduction to National Service Frameworks 2.1. What is a National Service Framework (NSF)? National service frameworks (NSFs) and strategies provides efficient quality requirements for care. These strategies are based on the available facts on which treatments and services can be effective for the patients. These strategies have various strengths that include building relationships with health professionals, patients, carers, health service managers, voluntary agencies and other experts. The historical perspective of NSF is to make a better world for the older people. England is said to be known as an aging society. Since the early 1930s the number of aged people was over 65 years. According to a recent survey, it has been found that every fifth population of England is over 60 and which will increase to 80 between 1995 and 2025. Thus the concept of NSF to build a better world for older people raised and they form this unit to take both social care and health care services. The National Service Framework is pioneer to ensure fair, high quality, integrated health and social care services for older people. This is a long term planning program which NSF ensures. It frames 10 year program of action raising awareness to promote good health, to support independence, special acre and services for any conditions and cultural change so that all older people and their carers so that they get respect and can live with dignity and equality. We need National Service Frameworks because it will give us support from every perspective to deal future condition of old age. It will help to create awareness for good health and making people conscious about stroke and hazards. The experts and hard work of NFS had led the way in developing the standards. The Goals and Purpose of NSF To improve standards of care To help older people to stay healthy Better long term funding Extending access to services The NFS will shape its services depending on individual patients, their families and their carers. [Standard 2] The NSF will support and value its staff. The NSF focuses on conditions like stroke, fall and mental health problems of older people. They have made 10 year framework to deal with arthritis, respiratory diseases in older people. To respect every individual Promoting healthy and active life 2.2. Introduction to National Service Framework for Older Adults- Stroke National Service Frameworks (NSFs) were established to improve various services by setting up national standards to check quality and care services. The main aim of this specific NSF Respecting the individual is the main aim. They give proper support and treatment to the patient and his family. They ensure better facility to the carers of the patients. Many major diseases are common in older people. This NSF sets standards to take care of these people by setting health and social services. The standards of the NSF focus on the condition of the older person whether the person can be taken care at home or in a nursing home or in hospital with intermediate care facility. Standard 5 depicts the condition related to Stroke. The NHS will take every action to prevent strokes. They will work in partnership with other agencies if necessary. They have provided facility for the people who had a stroke, to diagnose the disease, treated appropriately by a stroke specialist and also provided a multidisciplinary program of secondary prevention and rehabilitation. To reduce the incidence of stroke in the population and gives support to those had a stroke to integrate stroke care services. (National Service Framework for Older People, 2001, p.61) 3. Introduction to Stroke 3.1 What is stroke? Strokes are a kind of brain attack. They are usually caused by a blood clot and bleeding in the brain. Human being have stroke when an area of their brain does not get proper blood supply causing some brain cells to die. Stroke is defined as a clinical syndrome, of presumed vascular origin, developing disorder of cerebral functions for more than 24 hours. This can lead to death as well. An insufficient blood supply causes ischaemia and death of those brain cells dependent to the affected area. Pathophysiology- The central nervous system is made of the brain and the spinal cord. The human brain consists the cerebrum, the cerebellum and the brain stem. The clinical symptom that results for stroke are dependent on the site function of the affected brain region and the extent of damage that has occurred there (Mitchell and Moore, 2004, p.45). TIA- Transient ischaemic attack (TIA) is actually defined as an acute loss of focal and ocular function with symptoms lasting less than 24 hours and which due to inadequate cerebral and ocular blood supply which results in low blood flow that lead to disease of blood vessels, heart or blood (Mitchell and Moore, 2004, p.44). Ischaemic Stroke- When a clot occurs it will either narrow or block a blood vessel so that blood cannot reach the brain. This reduced blood flow causes brain cells in those particular area die due to lack of oxygen. This is considered to be the most common form of stroke. This type of diseases begins in childhood as fatty steaks are prominent in blood. (National Service Frame work for Older People, 2001). Haemorrhagic Stroke- When a blood vessel bursts, and blood leaks into the brain causing damage it is said to haemorrhagic stroke. It has a higher risk of fatality than ischaemic stroke and results from blood vessel rupturing and haemorrhaging into the brain. In such cases pressure can be exerted on the brain causing coma and death. This type of stroke is associated with hypertension, disorders of blood clotting (Mitchel and Moore, 2004, p.44). 3.2. Demographics It has been identified that people who are at high risk of stroke are at the age of 55years and above. Women with advance maternal age above 35 can be prone to stroke during pregnancy. (Geyer and Gomez, 2009, p. 126) Person with a migraine history can get a stroke attack too. (Welch et al. 1997) Hypertension and high blood pressure is dangerous to stroke as well. Family history can be another cause. Smokers are at higher risk of stroke as smoking causes accumulation of debris inside the blood vessels which is called artheroclerosis that contributes to blood clots. Apart from that, smoker tends to have more complications and recurrent strokes. (Smokers Twice as Likely to Have Strokes, 2011) The risk factors related to stroke at a glance are Hypertension (Cross, 2008, p.53), Smoking, Hypercholestrolaemia, Drinking too much Alcohol, High blood pressure, Previous stroke or transient ischaemic attack (TIA) (Mitchell and Moore, 2004, p.47), Other cardiovascular diseases, Poor diet, Diabetes, Lack of exercise, Obesity, Elevated Cholesterol and many more. These are the most widespread risk factors to cause stroke. 3.3 Epidemiology Stroke is common as well as serious. Stroke accounts nearly about 10% of all deaths in industrialized countries. Thus environmental factors can be more important than genetic history to determine risk of stroke. (Khaw, 1996) It is estimated that it causes 4.4 million deaths per year worldwide. Every year more than 110,000 people in England and Wales get their first stroke and 30,000 of them get attack by stroke again. It is the third most common reason of death in the UK. (Curley and RGN, 2004) In India stroke causes 102,620 million deaths. 12% of stroke takes place in the population aged less than 40 years. (Taylor and K, 2012, p.1) For instance people in less popular and underdeveloped areas and black Asian people are prone to have more strokes than people from developed and richer areas or white people. (National Stroke Strategy, 2008, p.6). In low income and middle-income countries, 85.5% of deaths takes place due to stroke and the amount of disability occurred approximately seven times than that in high income countries. (Taylor and Kumar, 2012, p.1) 3.4 Outcome Life after stroke becomes more critical depending on the situation of the patient. It is about the care and support people need in hospital and at home. It should be understood that people who had a stroke if they get proper support and care can recover fast and they need to live as independently as possible. About half of the people need rehabilitation at home for first 6months after getting discharged from the hospital. It will build up their confidence level. In case of younger people they want to go back to work after a stroke. Few people develop depression and some gets problem with speech and understanding. And a third of them die within 3 months (National Stroke Strategy, n.d. p.18). In long term recovery case rehabilitation is the best. Rehabilitation after stroke makes life much better and helps the people to get better soon. It may be long term and might have to flexible as people’s needs changes. (National Stroke Strategy) Rehabilitation includes discipline working together, may be prolonged periods, to develop patients' maximum independence (Stroke care: a nursing perspective, 2007, p.7). Stroke is the only cause of disability in adults. (Supporting life after stroke) In case of disability of the person needs special care. It is a long term factor. Many people have thinking and communicating problem in such cases they need understanding and very good care. Special equipments in a person’s home would help people who had a stroke and their carers to live independently (National Stroke Strategy, n.d., p.22). 3.5 Financial Burden The financial burden is a serious part of the stroke patient. For every patient who experiences a stroke,the cost to the NHS in the UK is around 15,000 euro over five years, and when informal care costs include in this increases to around 29,000 euro. ( National Audit Office, 2005, p.5) They provide short term and long term support and try to reduce the financial burden from the patient, family and carers. They make sure that patients are followed up by experts team care, including proper medical care facility and to prevent further strokes. In many places hospitals and government give facilities to the patient family to give money in instalment basis and also support the poor families with sometime free check up or a nominal payment for the treatment. Government of UK provides carers allowance which means is to give money to someone who needs to be cared like those who are affected by stroke. (Carers, n.d) 4. The Stroke Pathway Stroke is a serious disease. Thus the nature of a stroke patient must be serious too. It is important for the physicians to understand that brain is an essential tool for diagnosing stroke according to which treatment will pursue. It has been explained earlier that stroke cause by a blockage in one of the arteries connected to brain i.e. ischemic strokes. Acute stroke patients need thrombolysis treatment with thrombolytic agents within three hours oft he onset of symptoms. Reliable delivery of this an appropriately designed pathway. Immediate treatment of stroke could prevent a large number of people ending up with severe long term disability. (Stroke Care Pathway, 2006) Here it can identify with the condition of the patient which I have seen that the Patient X who is a 79 year old lady brought to the A & E department for treatment after diagnosing stroke attack using F.A.S.T screening tool by the paramedics. 4.1. Introduction The stroke care pathway is a resource that provides special care for people with stroke at any age in their care. The content of pathway is grounded in the evidence base for best practice management of stroke. The pathway is designed to facilitate the smooth transition of people suffering form stroke through the stages of recovery, from the acute phase, through rehabilitation, to the time when they are living with the effects of stroke in the community. The stoke pathway has the flexibility to be implemented in a number of different ways to suit the environment or circumstances in which it is to be applied. These pathways should be used as a guide for the range of services and interventions that need to be considered, and as a tool from which local protocols may be developed. (Stroke Care Pathway, 2006, p.1) Nurses play a vital role in the early assessment and initiation of stroke care. As a nurse one should demonstrate empathy which means having a feeling for the patient what the patient is going through,keeping herself in the patient’s situation. (Guidance for the care of older people, n.d) For instance it could be understood from the case that being a nurse prime responsibility is to help and send the patients to the required department for tests as soon as they arrived. Nurses are the sole health care professionals providing 24 hour intervention and serve an important role in the continuous therapeutic care and rehabilitation process. (Cross, 2008) 4.2. Diagnosis The Patient X who is suffering from stroke now brought down to the A & E department. A specialist nurse arrived from the stroke unit in the department. Patient X was assessed using the ROSIER tool. The aim of this Rosier tool is to enable medical and nursing staff to differentiate patients with stroke and stroke mimics. (Ford, n.d. p.1) . CT scan & MRI scans should be done as per requirement to check the brain blockage condition of the patient. I noticed as I was present on that spot, that everyone does not access the same treatment. As the time of the onset symptoms was not known, it was necessary for the nest level slot for a CT scan to be booked. As there was a long queue patient X being in such serious condition also had to wait like everyone else. Due to shortage of beds in the stroke unit patient was left in A & E for a further 3 hours before a bed became available on a general medical ward. 4.3. Treatment Stroke is though a fatal disease but it is curable with time and proper treatment. After diagnosing in the emergency room with Rosier tool, the next step of the treatment should proceed. Based on the examination CT & MRI scans should be done. It is the role of stroke specialist nurses in the stroke units to take care of that. The stroke units must have enough arrangements to consider and attend all the patients with stroke attack immediately. None of the patient should wait wait in the queue as happened with Patient X. Treatment includes timely brain scanning. A delay in treatment increases the risk of death and disability ( National Audit Office, 2005, p.5). Acute stroke patients, eligible for thrombolysis need immediate treatment with thrombolytic agents within 3 hours of onset of symptoms (Stroke pathway- delivering through improvement, 2009, p.2). 4.4. Medical considerations and nursing intervention Multidisciplinary interventions provided to manage the consequences of stroke. These are related to the goals set my the professional teams with patient and carers. Medical treatment may be used to control high blood pressure or artificial fibrillation among high risk patients. (Stroke Treatments, 2013) For Specialist Stroke Units, to develop guidelines on the management of acute stroke has become very important in the delivery of thrombolysis and other acute treatment. The inter professional plays a vital role in post stroke care along with nurses (Turner, 2008, p.35). Integrated care pathways involves complex inter-professional interventions used in stroke care.effective team functioning and integrated stroke services can reduce the rates of eventual disability and institutionalization (Cramm and Nieboer, 2011, p.1). Being a nurse firstly it is important to assess the stroke patient thoroughly to facilitate appropriate diagnostic and early interventions by providing thrombolysis, aspirin etc. Then continuously monitored the routine aspects of acute care and ensured timely completion of screening and assessments. It is needed to coordinate and reinforce lifestyle and other secondary prevention measures. The nurse should work with other members of the team to maximize the amount of active intervention required. They should ensure all assessments of the patients and carer to safe discharge from the hospital. (Clinical Guidelines for Stroke Management, n.d, p. 1) 4.5. Rehabilitation Rehabilitation is a process of re-education. Rehabilitation should be a combination of time spent with the therapist assessing and treating and with the patient practicing with other professionals like nurses or carers. (National Clinical guideline for stroke, 2012, p.32) Nurses in some areas are now starting to order CT scans. They give the first dose of aspirin and carry out the initial necessary things. (Cross, 2008, p. 51) As I have mentioned before about the patient X the lady who for attack by a stroke was unable to move her move her right limbs and was unable to speak clearly. In this condition the patient had to wait in the queue like everyone else, which should not happen here. Even the bed was unavailable in the stroke unit. She must have been given immediate treatment without any delay in the process. The government should develop this kind of facilities and provide such circumstances so that no patient have to wait with stroke attack. Occupational therapy to help adjustment back to the workplace. Physiotherapy to improve mobility and independence at home. The community based rehabilitation services should be available in all the areas including speech and language therapists, occupational therapists and physiotherapists. Diet support should be given as well. If required, equipment to support independent living should be given. 4.6. Health Promotion Discharge patients need improved access to rehabilitation and support services. Thus Stroke awareness measures should be taken. The nurses should educate the patients and their families regarding the lifestyle and diet. The person should live a healthy lifestyle after stroke attack. Smoking , drinking should be avoided, nutritional diet is necessary. Most of the national bodies, hospitals, local government usually does health promotion to educate general people to prevent stroke and regarding after stroke lifestyles. Different factors like weight management, high blood pressure control, control of hypertension, along with regular exercise after recovery is must to lead a healthy life. Nurses play very important role in relation to the health promotion. They are the first carers to understand the patient conditions and based on that they educate the patient and their families to take care and maintain a healthy life. 5. Relevance to National Agenda 5.1. NICE Quality Standards for Stroke (2010) The nice quality standards define a high standard of care for stroke published in June 2010. The National Institute of Health and Clinical Excellence (NICE) standards covers care provided to adult stroke patients by healthcare staff during diagnosis and initial management, acute phase care, rehabilitation and long term management. Act F.A.S.T. campaign has been launched by NICE in February 2007. F.A.S.T stands fro Face-Arm-Speech-Time, a test to help people recognize the first signs of stroke and understand the importance of emergency treatment. 5.2. The National Stroke Strategy The National Stroke Strategy, launched in December 2007, sets a clear direction for the development of stroke services in England over a 10 year period. The strategy has been developed in partnership with representatives from stroke charities, stroke professionals’ in the NHS, social care professionals and those affected by stroke and their carers. The strategy is an evidence based document, mentioning about the needs to be done across the care pathway. (National service frameworks and strategies, n.d) 5.2.1 NHS Health Check The NHS Health check assesses people’s risk of heart disease, stroke, kidney disease and diabetes according to their age, gender, family history, height and weight, as well as their blood pressure and cholesterol level. Everyone gets a personal check up and diagonise their personal level of risk and strategies to reduce it. Various advice has been given like stop smoking services, weight management programs etc. People with higher risk will get a preventive medication with blood pressure treatment as per requirement. NHS Health Checks have he potential to prevent 1600 heart attacks and strokes and save up to 650 lives each year. 5.2.2. National Stroke Association Mission of National Stroke Association is to reduce the incidence and impact of stroke by developing compelling education and programs focused on prevention, treatment, rehabilitation and support for all who has an impact of stroke. (National Stroke Association, n.d) 5.2.3. American Heart Association (AHA) AHA has created guidelines for emergency stroke care. An AHA quality improvement program called “Get with the Guidelines”, evaluates and recognize hospitals for their quality of stroke care. The programs called data and quality measures. They are like the amount of time requires to complete an MRI or CT scan of a suspected stroke patient;s brain for each enrolled hospital. (Stroke Victims not receiving timely Diagnosis, Care, 2012) 5.3. The role of voluntary sector and families and carers People who had a stroke and their carers need to able to access a range of services after they have been transferred to home. Many of the patients need further community based rehabilitation like physiotherapy speech and language therapy or occupational therapy. Many stroke survivors and carers also need broader support to help them manage life after stroke, such as the support and advice provided by local stroke and carer groups, families to take part in community activities. Several ‘stroke pathway’ had been implemented setting out how care should be taken provided in the days and weeks following a stroke, but only half of these included long term support. (Supporting life after stroke, n.d., p.15) The support that carers receive can help them to maintain their independence and cope with life after some had a stroke. This type of supports is provided from different range of organizations including NHS, social care and voluntary sector. Social cares plays an important role as they help to assess the needs of the carers. Carers in most of the places can access general information, advice on benefits and short breaks. Many also accesses to general carer support groups and emotional support. 90% benefits and financial advice are available most of the areas. 80% support for carers to stay at work, general carer support groups around 75%. Stroke carers support groups around 60%. Expert carer training more than 45% provided in all areas. Around 46% had provided staff in care homes with some training in issues to raise awareness of stroke and communicating with people where communication is required. (Supporting life after stroke, n.d. pp. 16-17) 6. Progress to date From this report it is understood that various measures have been taken to battle with stroke throughout the world. Many National policies have been made and various national bodies built up to provide care and service. These associations had their own goal set. In most of the cases the progress has been made towards the goal set. Keeping in mind few more should be considered next time. National Sentinel Stroke Clinical Audit 2010 (Round 7) had framed these changes to be made. They have mentioned that patients suffering from ischaemic stroke in AF should be considered for anticoagulation, and a clear statement should be given to take decision for not providing treatment to the patient. Proper hospital records should be maintained to link the pre hospital information held by paramedics. All patients should get immediate admission to a stroke unit equipped to manage acute stroke patients and have access to a stroke service that can deliver thrombolysis safely and effectively. None of the patient should be admitted permanently to a care home without proper attempt to rehabilitate the patient in hospital. Therapy time should be kept delivering direct patient care instead of administrative work. Patients should get their brain scanned within 24hrs of admission. Every unit should timely assess their patients by a social worker and after 7 days referral given none of the patient should wait. Case notes of all patients with a documented plan of continence problems should be made. Stroke specialist early supported discharge should be made available everywhere. Lastly patient should have documented evidence that relates stroke diagnosis, prognosis and management of lifestyle risk factors. A patient who drives their risk of driving ability should be discussed and documented as well. (Henssge et al. 2011, p.11) 7. Conclusion From this entire report it should be understood that the nurse plays a vital role in every step of of Stroke pathway. The National Service Framework has made for Older Adults in terms of stroke that is Standard 5 has made a great impact on the society to enlighten about the risk and prevention of stroke. It is important that those who had a stroke should get proper treatment immediately with any kind of negligence and delay by the hospital community. So at the end it very important to mention that stroke can transform any individual with relationships, occupations and plans to a patient with compromised function, mentality and dignity. It can have devastating effects on patients' quality of life. Therefore nurses need to understand the effects of stroke on patients and their families and give immense support to recover that (Collins, 2007, p.39). Hence, readers of this report should understand that to be healthy is our duty. And to take care of the older people as like any other person is foremost important without any discrimination. Thus everybody should be treated equally and with proper care in such conditions of stroke attack. REFERENCES 1. Collins, C (2007) Pathophysiology and classification of stroke. Nursing Standard. Vol 21 no 28 2. Curley C and RGN D.P (2004) Reducing deaths from stroke: Nursing older people October vol.16 no7 3. Cross, S. (2008) Stroke care: a nursing perspective. Learning zone continuing professional development. Nursing Standard: vol 22 no 23 4. Clinical Guidelines for Stroke Management (n.d) Stroke Foundation. Available at: http://strokefoundation.com.au/site/media/NSF_Concise-Guidelines_Nursing_2011.pdf (accessed on July 4, 2013) 5. Cramm and Nieboer (2011) Professionals’ view on interprofessional stroke team functional. International Journal of Integrated Care vol 11. Igitur Publishing 6. 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